Abdominal Wall Transplantation and Technique

Many patients undergoing intestinal or multivisceral transplantation have a past history of complete midgut removal with the loss of the domain of the abdominal compartment or have severely damaged abdominal walls from repeated laparotomies or enterocutaneous fistulae. These patients may encounter severe abdominal wall closure problems at the end of transplantation, resulting in increased morbidity and mortality. It is, therefore, of paramount importance to properly cover transplanted organs in order to reduce postoperative complications. Abdominal wall transplantation was proposed for closure of patients undergoing both small bowel and multivisceral transplantation. We present our experience in abdominal wall transplantation in which, by taking advantage of microsurgical experience, we were able to re-vascularize the composite tissue allograft anastomosing the deep inferior epigastric vessels of the graft to those of the recipient. This technique allows to preserve donor’s vascular pedicle that can be used as grafts for vascular procedures.